# Evidence based health --- ## As defined by Sackett (1996) > Evidence based medicine is the **conscientious**, **explicit**, and **judicious** use of **current best evidence** in *making decisions* about the care of individual patients. --- ## What is it? - Conscientious: With Awareness, Expert - Explicit: Defined steps and processes - Judicious: Judgement, appraisal based - Knowledge of Mechanisms + Empirical Research - Use of empirical evidence --- ## Alternatives to Evidence based health - Eminence based health - Biological mechanism based health care only --- ## Challenges - Explosion of studies - RCT/90 minutes - Need to integrate - Need rapid reviews - Condensed summaries --- ## Steps - Frame a question - Search literature - Critical appraisal - Synthesis --- ## Framing a question - PICO format - Not all questions can be framed with PICO, - For descriptive questions use PO - Background and foreground questions --- ## Boolean Logic  --- ## Literature search - Boolean logic - Logic of "AND": restricts - Logic of "OR": expands - Logic of "NOT": restricts --- ## Critical appraisal - Identify biases - Estimate whether the effects are going to be useful for your own clinical or evidence based question - Match whether the findings will be applicable to the specific situation --- ## Summary - 1 - Evidence based health is the new paradigm - It has four steps - Start with Asking a Question - Conduct a focused search of literature --- ## Summary - 2 - Read widely but selectively - During critical appraisal, - Learn how to spot biases - Learn how to assess what is meaningful effect size - Learn how you can apply the study to your own setting